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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153905896
Report Date: 10/05/2021
Date Signed: 10/05/2021 01:40:07 PM

Document Has Been Signed on 10/05/2021 01:40 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:GOMEZ, YOLANDA FAMILY CHILD CAREFACILITY NUMBER:
153905896
ADMINISTRATOR:YOLANDA GOMEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 735-5233
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
10/05/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Yolanda GomezTIME COMPLETED:
02:00 PM
NARRATIVE
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On 10/5/21 Licensing Program Analyst, (LPA) Caroline Harris conducted an unannounced annual inspection. LPA met with Licensee, Yolanda Gomez. Also present was her husband and assistant. LPA conducted a tour of the home, inside and outside, as shown on the facility sketches (LIC 999A) provided. The LPA observed all required licensing forms to be posted in a visible location for authorized representatives to view them. A census was taken and there were four day care children present. The LPA observed the licensee to have one dog that was inaccessible to children. The licensee is aware of the safety of children around animals and takes responsibility for any action taken by her pets. The LPA observed inaccessible rooms to be off limits to children by the use of door locks. However, during the inspection, the LPA observed the downstairs bedroom, and garage to be unlocked and accessible to children. The accessible rooms were the living room, dinning room, hall bathroom, kitchen, laundry room and back yard. The outdoor play area in the back yard is fenced. Licensee is aware that children are to be supervised when outside an unfenced play area. Swimming pool is fenced per regulation. The LPA observed safe toys and play equipment both indoors and outside. During the inspection, The LPA observed the hall closet to contain Calamine Lotion and other keep out of reach items that were on a lower shelf and accessible to children. The latch under the bathroom sink was also not latching and there was keep out of reach items accessible. LPA observed bug killer on the floor of the laundry room. The licensee's shed in the back yard was also unlocked and had poisonous chemicals in it. Licensee is aware that poisons are required to be locked and inaccessible to children. There are no firearms or ammunition present at this facility. Fireplace is not in use during day care hours. There is a working fire extinguisher, smoke detector, carbon monoxide indicator, and adequate heating and ventilation for safety and comfort. The licensee has a complete first aid kit, including bandages, scissor, thermometer, gloves and a first aid manual. Stairs are barricaded when children under age 5 years old are present. There is a working telephone and the above telephone number was verified. Adequate supervision is being provided during this visit. Capacity as specified on the license is being maintained.
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/05/2021 01:40 PM - It Cannot Be Edited


Created By: Caroline Harris On 10/05/2021 at 11:59 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: GOMEZ, YOLANDA FAMILY CHILD CARE
FACILITY NUMBER: 153905896

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/05/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the LPA observed the hall closet to contain Calamin Lotion and other keep out of reach items that were on a lower shelf and accessable to children. The latch under the bathroom sink was also not latching and there was keep out of reach items accessable. The shower also had personal hygene items at the bottom of the shower. This poses a potential health, safety or personal rights risk to children in care.
POC Due Date: 10/05/2021
Plan of Correction
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During the inspection, the licensee placed all keep out of reach items up and inaccessable to children.
Type B
Section Cited
CCR
102417(g)(4)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. (A) Storage areas for poisons, firearms and other dangerous weapons shall be locked.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the LPA observed bug killer on the floor of the laudry room. The licensee's shed in the back yard was also unlocked and had poisonious chemicals in it. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/05/2021
Plan of Correction
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During the inspection, the licensee locked the shed and placed the bug killer in a locked cabnet.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Alice Juarez
LICENSING EVALUATOR NAME:Caroline Harris
LICENSING EVALUATOR SIGNATURE:
DATE: 10/05/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/05/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/05/2021 01:40 PM - It Cannot Be Edited


Created By: Caroline Harris On 10/05/2021 at 12:56 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: GOMEZ, YOLANDA FAMILY CHILD CARE
FACILITY NUMBER: 153905896

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/05/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)


This requirement is not met as evidenced by:
Deficient Practice Statement
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During the inspection, the LPA observed the downstairs bedroom, and garage to be unlocked and accessible to children. These are inaccessible areas. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/05/2021
Plan of Correction
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The LPA had the licensee circle areas of access and cross out areas of inaccessibility on her facility sketches. The licensee understands that she can not have these rooms unlocked during day care hours.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Alice Juarez
LICENSING EVALUATOR NAME:Caroline Harris
LICENSING EVALUATOR SIGNATURE:
DATE: 10/05/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/05/2021


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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: GOMEZ, YOLANDA FAMILY CHILD CARE
FACILITY NUMBER: 153905896
VISIT DATE: 10/05/2021
NARRATIVE
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LPA reviewed five children’s files. All required licensing documents were observed in each of the children’s files, including a copy of the Family Child Care Home Notification of Parent's Rights (LIC 995A). Licensee also maintains documentation of immunizations for the children. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services.

Fire drills are conducted and documented with the date, time and how many children present, every six months. Licensee is aware that children are never to be left in parked vehicles. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the home and prevented from returning to the home or having contact with children in care. Licensee is aware that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice. Pediatric CPR/First Aid are current and expire on 2/11/22. Licensee maintains documentation of immunizations against pertussis, measles and influenza for herself and staff. Days and hours of operation are Monday – Friday; 6:00 AM – 6:00 PM.

An exit interview was conducted with the Licensee. LPA reviewed with licensee the Mandated Child Abuse Reporter Training (AB 1207), which the licensee completed on 7/30/21. It is required to be updated every two years. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: GOMEZ, YOLANDA FAMILY CHILD CARE
FACILITY NUMBER: 153905896
VISIT DATE: 10/05/2021
NARRATIVE
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LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. There is one crib or play yard for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants (0-24 months) every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping. The LPA and licensee discussed the Community Care Licensing website: www.ccld.ca.gov. which provides access to Provider Information Notifications (PINS), Quarterly Updates that inform licensees of new legislation and regulations, training's, and Licensing forms and updated information. The licensee was also advised that it is her responsibility to stay current with regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are found (see next page): 809 D

An exit interview was conducted and a copy of this report, along with appeal rights was provided to the licensee, Yolanda Gomez and was reviewed. This report shall be made available to the public upon request. The LIC 9213 Notice of Site Visit form was provided to the licensee and must remain posted for 30 days.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021
LIC809 (FAS) - (06/04)
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